Hospitals delay non-urgent operations in bid to reduce NHS deficits

Patients are being forced to wait for treatment so NHS trusts can balance their books.

Several primary care trusts (PCTs) confirmed they had a policy of imposing some form of minimum wait so that patients were not seen too quickly.

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Kingston PCT has a standard 10-week wait for outpatient appointments while Suffolk PCT said routine procedures should not be carried out before 98 days had passed.

North Yorkshire and York PCT keeps patients on their waiting list for a minimum of 20 weeks. The confirmation that more PCTs are adopting such a policy comes as a report out today says 2007 will be a "make or break" year for the NHS.

The study, from the think tank Reform, said rising costs have not been addressed and there has been a failure to invest in modern services.

This has led to a service that is weaker in the long-term than it was two years ago, it added. One solution would be to write off NHS debts and reform the way patient services are managed, said the report, NHS reform: the empire strikes back.

The authors, led by Nick Bosanquet, Professor of Health Policy at Imperial College London, believe the service could be salvaged through a three-year programme.

This would include writing off debts and introducing "rigorous financial discipline" so that all organisations are in surplus or balance. The NHS finished last year more than £500 million in debt but its budget has increased over recent years.

In 2010, the NHS in England will spend well over £100 billion per year (more than £4,500 per household).

Prof Bosanquet said: "The Department of Health has been so busy fire-fighting that it has not developed a process for getting real value.

"The beginning is the abolition of deficits to allow a fresh start; then investment in new services and competition can follow."

Speaking on BBC Radio 4's Today programme, Prof Bosanquet added: "Unless we get to grips with the dynamics of the decline that is taking place in the NHS, patients are going to face worse and worse access to services.

"That's why we are saying as a start we have got to write-off debts. At the present the debt write-off is hopelessly confused with the re-engineering and change in services."

His report argues that key reform programmes were delayed in 2006 or showed disappointing progress.

Furthermore, the Department of Health failed to control, or even measure, the spiralling long-term costs of staffing and infrastructure.

"Centrally imposed initiatives and costly targets have plunged the NHS into a record deficit.

"The NHS needs greater freedoms at a local level, and not more centralisation, to return it on a stable and sustainable financial footing."

A spokesman for the Department of Health said: "There is no question of deficits being wiped out - it would be unfair for overspending organisations to be bailed out by those that underspend."

The trusts keeping patients on waiting lists said the policy only affected non-urgent cases. Caroline Tuohy, director of commissioning and development at Suffolk PCT, said: "We do ask acute trusts not to carry out routine procedures before 98 days and we do this to ensure everyone is seen in turn.

"It only applies to patients who have been referred for routine procedures. "Patients who need to be seen urgently are of course seen as quickly as possible."

A spokesman for North Yorkshire and York PCT confirmed there was currently a 20 week minimum wait. At the end of October 2006, the PCT had a £14.8 million deficit.

The spokesman said: "As our partners and others would expect, the PCT's current financial position means that we must take urgent action to ensure we can return to financial balance as soon as possible - we are not in a position to be able to continue to work as we have done in the past.

"People are still having their operations much more quickly than ever before, and these waits are reducing further.

"By December 2008 the maximum any patient can wait from referral to treatment will be 18 weeks. This represents a huge improvement, and the PCT is working closely with hospital trusts to achieve this."

A spokesman for the Department of Health said: "Within the maximum waiting time targets, it is for clinicians to ensure that patients are seen according to clinical priority.

"Nationally, most patients wait much less than six months with the average wait for planned treatment being around seven weeks.

"This is an operational issue for the local NHS. As the Primary Care Trusts in question make clear, urgent cases will receive priority and no targets are being breached."